Published online October 31, 2008
PEDIATRICS Vol. 122 Supplement November 2008, pp. S130-S133 (doi:10.1542/10.1542/peds.2008-1055e)
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SUPPLEMENT ARTICLE


Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children

Robert M. Kennedy, MDa, Janet Luhmann, MDa and William T. Zempsky, MDb,c

a Department of Pediatrics/Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri
b Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
c Pain Relief Program, Connecticut Children's Medical Center, Hartford, Connecticut

Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children's acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

Key Words: venipuncture • peripheral cannulation • pain • nociceptors • psychophysiology • developmental biology

Abbreviations: IV—intravenous • ED—emergency department

Accepted Jun 4, 2008.


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W. T. Zempsky
Optimizing the Management of Peripheral Venous Access Pain in Children: Evidence, Impact, and Implementation
Pediatrics, November 1, 2008; 122(Supplement_3): S121 - S124.
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